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No touchy, no feely

Trapped in the broccoli aisle at the supermarket, Dr. Kate Scannell listened as a former patient complained about his new doctor’s uncaring demeanor. A grocery clerk chimed in with “Tell me about it. I don’t think mine has touched me in – gosh, years, actually.”

In an essay that recently appeared in the Contra Costa (Calif.) Times, Dr. Scannell wonders: Can you be a doctor without ever touching a patient?

Once upon a time, the laying on of hands was an important clinical skill, she laments. “Hearts were heard, skin was inspected, pulses were palpated, livers were percussed. Physicians literally ‘had a hand’ in keeping you healthy.”

But no longer. Nowadays, the knowledge gained through touch has largely been replaced with medical tests and technology. “Most of us doctors probably touch a computer keyboard at least a thousand times more often than we touch a patient throughout the course of a workday,” Dr. Scannell writes.

And because of this, the doctor-patient relationship has lost something valuable, she writes:

Steve Wilkins, a former hospital executive and consumer health behavior researcher who blogs about doctor-patient communication at Mind the Gap, has been reflecting recently too on the power of touch. Touch often can help convey feelings and emotions more accurately than facial expressions, gestures or even words, Wilkins writes. He cites research findings on the ability of touch to reduce cortisol, a hormone produced by the body when it’s under stress.

“I suspect we could use a whole lot more touching… not less as is the trend,” Wilkins concludes.

There doesn’t seem to have been much research on the role of touch in the clinical setting. Many of the studies, at least to date, focus on therapeutic touch within the context of complementary medicine. There’s also considerable evidence that babies benefit, both physically and emotionally, from being touched, held and cuddled early in life, and fail to thrive without it. But when it comes to adult patients in the hospital or doctor’s office, the studies register a gap.

Perhaps it’s not surprising. This is an area that can be a minefield for everyone involved. When Wilkins’s blog entry was crossposted this week at Kevin, MD, some of the commenters pointed out that many patients dislike being touched and the familiarity this implies.

“I don’t particularly enjoy being touched by anyone other than people who are very close to me, like my husband, or siblings,” one person wrote. “It’s unpleasant when my employees and acquaintances hug me, and I really dislike people who invade my personal space or touch me in any way other than a business-like handshake. Being touched is highly stressful.”

“Touch is not therapeutic unless the patient perceives it that way,” someone else commented.

On many levels, it’s hard to blame clinicians for keeping their distance. How are they supposed to know how an individual patient will respond to a pat on the shoulder or a hug? A gesture that’s misunderstood could lead to accusations of impropriety and sully someone’s reputation for life, even when the clinician isn’t at fault. Far better for everyone to keep their hands to themselves.

It’s a fine line, admitted one of the commenters at Kevin, MD. “I have one doctor who puts his hand on my shoulder when he leaves the room. To me it’s a comforting gesture that the visit went well. I suppose some might view this as unwanted familiarity.”

To be sure, there’s a difference between clinical touch that’s necessary for a physical exam or to carry out a procedure, and personal touch such as a hug or handshake that belongs to the relationship aspect of the doctor-patient encounter. Overall, though, there seems to be less touching, period. Is it out of line to wonder whether this might be one of the factors contributing to the alienation many people sense between doctors and patients? Even when they don’t like being touched too often, most people notice when touch is absent. In this, we are all human.